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Discrepancy between total white blood cell counts and serum C-reactive protein levels in febrile children
Ville Peltola1, Pia Toikka, Kerttu Irjala
1Department of Pediatrics, Turku University Hospital, Turku, Finland. ville.peltola@tyks.fi
Insights
In febrile children, white blood cell (WBC) counts and C-reactive protein (CRP) levels often differ. Measuring both inflammatory markers improves the detection rate of bacterial infections.
Area of Science:
- Pediatrics
- Clinical Chemistry
- Infectious Diseases
Background:
- White blood cell (WBC) counts and C-reactive protein (CRP) are standard inflammatory markers for febrile children.
- Discrepancies between WBC and CRP levels are common but their clinical significance requires further study.
Purpose of the Study:
- To investigate the occurrence and clinical significance of discordant WBC and CRP levels in febrile children.
- To evaluate the diagnostic utility of combined WBC and CRP measurements in identifying severe bacterial infections.
Main Methods:
- Retrospective review of medical records of febrile children (age >= 1 month) over a 2-year period.
- Analysis of children with elevated WBC (>= 15 x 10(9)/l) and/or CRP (>= 80 mg/l), and those with low levels in both parameters.
- Comparison of the incidence of severe bacterial disease across groups with concordant high, discordant, and low inflammatory marker levels.
Main Results:
- WBC and CRP levels were discordant in 556 children and concordantly high in 194 children.
- Severe bacterial disease was presumed in 57% of children with concordantly high markers, 20% with discordant markers, and 5% with low markers (p<0.001).
- Non-streptococcal tonsillitis was the most frequent viral infection associated with elevated WBC and CRP.
Conclusions:
- Discrepancies between WBC and CRP are common in febrile children.
- Simultaneous measurement of WBC and CRP significantly enhances the detection rate of bacterial infections.
- Combined inflammatory marker assessment aids in differentiating bacterial from viral infections in febrile children.
Abstract:
Total white blood cell (WBC) counts and serum C-reactive protein (CRP) are used as inflammatory markers in febrile children. We studied the occurrence and clinical significance of discrepancy in these markers. From a 2-y period, we retrospectively reviewed the medical records of febrile children (> or =1 month of age) with WBC > or =15 x 10(9)/l and/or CRP levels > or =80 mg/l, as well as of children with lower values in both these parameters. WBC and CRP were discordant in 556 children and concordantly high in 194 children. A severe bacterial disease was presumed in 57% of children with concordantly high WBC and CRP, in 20% of those with discordant values, and in 5% of those with low levels of these markers (p<0.001). Non-streptococcal tonsillitis was the most common viral infection associated with elevated WBC and CRP. In conclusion, WBC and CRP are commonly discrepant in febrile children. Measuring both markers increases substantially the detection rate of bacterial infections.
